<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Activity_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-activity_id" data-rule="required" data-source="activity/index" class="form-control selectpage" name="row[activity_id]" type="text" value="{$row.activity_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Data1')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-data1" class="form-control" name="row[data1]" type="text" value="{$row.data1|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Data2')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-data2" class="form-control" name="row[data2]" type="text" value="{$row.data2|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Data3')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-data3" class="form-control" name="row[data3]" type="text" value="{$row.data3|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Data4')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-data4" class="form-control" name="row[data4]" type="text" value="{$row.data4|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
